Tanaka M, Watanabe S, Ashimura H, Akiyoshi Y, Nishijima Y, Sato S, Naito H
Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
Anesth Analg. 1993 Nov;77(5):942-6. doi: 10.1213/00000539-199311000-00012.
Recent studies have produced conflicting results regarding whether the addition of epidural fentanyl improves postoperative analgesia from epidural morphine. Therefore, we prospectively determined the dose-response relationship and the minimum effective combination dose of epidural morphine and fentanyl (fentanyl given after morphine) for posthysterectomy analgesia. We studied 120 patients undergoing radical abdominal hysterectomy. All patients had epidural lidocaine 1.5% with epinephrine (1:200,000) for surgical anesthesia followed by light general anesthesia with endotracheal intubation. They were assigned randomly into six groups according to the combination of each narcotic dose: morphine 2 mg, morphine 2 mg/fentanyl 50 micrograms, morphine 2 mg/fentanyl 100 micrograms, morphine 4 mg, morphine 4 mg/fentanyl 50 micrograms, and morphine 4 mg/fentanyl 100 micrograms. Morphine and fentanyl were given epidurally in a double-blind manner approximately 60 and 15 min, respectively, before the completion of surgery. For 2 mg of morphine, the addition of 50 or 100 micrograms of fentanyl improved pain relief during the first 6 h postoperatively (P < 0.05), provided longer duration of analgesia (P < 0.05), and required less analgesic supplement (P < 0.05), but did not alter the incidence of side effects. For 4 mg of morphine, the same conclusion was drawn, except that vomiting occurred more frequently with addition of 100 micrograms of fentanyl (P < 0.05). Among fentanyl groups, there was no significant difference in pain scores, duration of analgesia, and analgesic requirements. Therefore, we conclude that epidural fentanyl given after morphine improves early postoperative analgesia from epidural morphine, and the minimum effective combination dose is morphine 2 mg/fentanyl 50 micrograms for posthysterectomy surgery analgesia.
近期研究对于硬膜外给予芬太尼是否能增强硬膜外吗啡的术后镇痛效果产生了相互矛盾的结果。因此，我们前瞻性地确定了硬膜外吗啡和芬太尼（吗啡给药后再给予芬太尼）用于子宫切除术后镇痛的剂量反应关系及最小有效联合剂量。我们研究了120例行根治性腹式子宫切除术的患者。所有患者均接受1.5%利多卡因加肾上腺素（1:200,000）的硬膜外麻醉用于手术，随后行气管插管的浅全身麻醉。根据每种麻醉剂剂量的组合，将他们随机分为六组：吗啡2mg、吗啡2mg/芬太尼50微克、吗啡2mg/芬太尼100微克、吗啡4mg、吗啡4mg/芬太尼50微克、吗啡4mg/芬太尼100微克。吗啡和芬太尼分别在手术结束前约60分钟和15分钟以双盲方式硬膜外给药。对于2mg吗啡，添加50或100微克芬太尼可改善术后前6小时的疼痛缓解（P<0.05），延长镇痛持续时间（P<0.05），且所需的镇痛补充剂更少（P<0.05），但未改变副作用的发生率。对于4mg吗啡，得出了相同的结论，只是添加100微克芬太尼时呕吐更频繁（P<0.05）。在芬太尼组中，疼痛评分、镇痛持续时间和镇痛需求方面无显著差异。因此，我们得出结论，吗啡给药后硬膜外给予芬太尼可增强硬膜外吗啡的术后早期镇痛效果，子宫切除术后镇痛的最小有效联合剂量为吗啡2mg/芬太尼50微克。
